BACKGROUND We quantified, among diabetic adults, the frequency, costs, and factors associated with visits to the emergency department (EDs) and subsequent hospitalizations for acute hypoglycaemic and hyperglycaemic events. METHODS We included adults with diabetes residing in the Milan Agency for Health Protection between 2015 and 2017. From healthcare databases, we identified demographic variables, comorbidities, type of treatment, insulin treatment duration, previous ED attendances for acute glycaemic events, and two indicators of glycaemic monitoring. Using a validated ICD-9-CM coding algorithm, we identified all ED attendances for acute glycaemic events from the ED database and calculated their incidence. We computed the direct costs from health databases and presented them as average annual mean costs for those having had at least an ED attendance. The analysis of the association between the number of ED attendances and potential determinants was performed using zero-inflated negative binomial regression models. These two-part models concomitantly estimate two sets of parameters: the odds-ratios (ORs) of having no attendances and the incidence rate ratios (IRRs) of attendance. RESULTS The cohort included 168,285 subjects, 70% of subjects were older than 64 years, 56% were males, and 26% were treated with insulin. The incidence of acute glycaemic events for those attending the ED was 7.0 per 1000 patient-years, followed by hospitalization 26.0% of the time. The total annual direct cost for ED attendances due to acute glycaemic events was 174,000 €. Type of antidiabetic treatment had the strongest association with ED attendances for hypoglycaemia. Patients assuming insulin only had a lower probability of having no attendances (OR compared to those who assumed non-insulin antidiabetic drugs =0.01, 95% CI = 0.00-0.02). These patients also had the highest rate of hyperglycaemic episodes (IRR = 7.7, 95% CI = 5.1-11.7 for insulin only vs. non-insulin antidiabetic drugs). Subjects having had a previous episode of the same type leading to an ED visit had a higher rate of subsequent attendances (IRR for hypoglycaemia = 5.3, 95% CI = 3.9-7.3 and IRR for hyperglycaemia = 3.7, 95% CI = 1.3-10.2). CONCLUSION Insulin treatment and having had a prior acute glycaemic event leading to an ED visit were major predictors of ED attendance for hyper and hypoglycaemia in a population of adults with diabetes.

中文翻译：

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米兰都会区成人糖尿病患者的急诊高血糖和低血糖症：量化该现象并研究其预测因素。

背景技术我们对糖尿病成年人中与急诊就诊（ED）以及随后因急性降血糖和高血糖事件住院治疗相关的频率，费用和因素进行了量化。方法我们纳入了2015年至2017年之间居住在米兰健康保护局的成年人糖尿病患者。从医疗保健数据库中，我们确定了人口统计学变量，合并症，治疗类型，胰岛素治疗持续时间，既往急诊就诊的急性血糖事件以及两项指标血糖监测。使用经过验证的ICD-9-CM编码算法，我们从ED数据库中识别出所有ED急性血糖事件的出勤率，并计算了它们的发病率。我们从健康数据库计算了直接费用，并将其表示为至少参加急诊就诊的患者的平均年均费用。急诊就诊人数与潜在决定因素之间的关联性分析是使用零膨胀负二项式回归模型进行的。这些由两部分组成的模型会同时估计两组参数：无出席人数的赔率比（OR）和出席人数的发生率比率（IRR）。结果该队列包括168,285名受试者，其中70％的受试者年龄超过64岁，男性的受试者为56％，胰岛素治疗的受试者为26％。急诊就诊者的急性血糖事件发生率为每1000患者年7.0，其次住院率为26.0％。由于急性血糖事件，急诊就诊每年的直接总费用为174，000€。抗糖尿病治疗的类型与低血糖的急诊就诊率最强相关。仅接受胰岛素治疗的患者就诊的几率较低（与那些接受非胰岛素抗糖尿病药物治疗的患者相比，OR = 0.01，95％CI = 0.00-0.02）。这些患者的高血糖发作率也最高（仅胰岛素相对于非胰岛素抗糖尿病药，IRR = 7.7，95％CI = 5.1-11.7）。曾经历过相同类型发作导致ED访视的受试者随后的出勤率更高（低血糖的IRR = 5.3，95％CI = 3.9-7.3和高血糖的IRR = 3.7，95％CI = 1.3-10.2 ）。